Simple Excision and Wound Closure

Simple skin excision is a minor operation done as an out-patient procedure.  It is the management of choice for cysts and mass on the skin, benign or malignant.  The procedure entails taking out of the entire lesion under local anesthesia.

Wound closure is a procedure done after a skin excision.  Different sutures are used depending on the location of the body and the amount of tension exerted on the wound where it will be applied.

Different types of wound closure are:

SUTURE TECHNIQUES

Simple interrupted suture = Most common. Done symmetrically on both sides of the wound starting by placing needle perpendicular to epidermis, traversing it and the entire dermis and then exiting perpendicular to the opposite epidermis. Even bites of needle to the tissue is important to maintain same level and edges of the wound.

Simple running suture = aka continuous suture.  It is an uninterrupted series of simple interrupted sutures.  Starts out as a simple interrupted stitch, and a series of simple suturing are placed in equal distance and depth in succession WITHOUT cutting or tying the suture after each pass.  The knot is placed at the exit of the wound.

Subcuticular suture stitch = horizontal suturing bites are placed along the length of the wound

through the papillary dermis on alternating sides of the wound, no suture marks are visible.

Horizontal mattress suture = placed by entering the skin 5mm to 1cm from the wound edge, then the suture is passed deep in the dermis to the opposite side of the suture line and exits the skin same distance as it entered from the wound edge.  The needle reenters the skin on the same side of the suture line 5mm to 1cm lateral of the exit area.  The stitch passes deep to the opposite side of the wound and exits the skin.

Vertical mattress suture = first starts as a simple interrupted suture placed wide and deep into the wound edge then a more superficial interrupted stitch is placed closer to the wound edge and in the opposite direction.  The higher the tension of the wound, the wider the stitch should be.

NON-SUTURE

Wound closure tapes = used for low-tension wounds. Strips of microporous surgical adhesives used as tapes to provide support to a wound. Example: Steri-strips

Staples = stainless steel staples are used for high tension wounds over trunk or scalp

Tissue adhesives = 2-octyl cyanoacrylates over wounds with thin skin

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